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Identification of factors which influence health after a cardiovascular disease (CVD) event will assist with reducing the high health and economic burden of CVD. We undertook a systematic review to investigate the association between social health (lower social isolation, higher social support and lower loneliness) and health and well‐being after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched until June 2020. Two reviewers undertook title/abstract screen. One reviewer undertook full‐text screen and data extraction. A second author either independently extracted or checked data. Narrative thematic analysis was undertaken. Of the 752 unique records retrieved, 39 papers from 29 studies met our inclusion criteria. Included studies recruited between 10 and 1,455 participants, aged 12–96 years, and the majority were male. Greater social health was consistently associated with better mental health outcomes (lower depressive symptoms, anxiety symptoms and psychological distress). Lower social isolation and higher social support were associated with the extent to which patient needs were being met. Living situation was not associated with mental health outcomes, and being married or living with someone was associated with greater medication adherence. Our systematic review demonstrates that greater social health is associated with better mental health outcomes and met patient needs among cardiac patients. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies when assessing health outcomes among CVD patients. Our review highlights the need for more research focused on women and the importance of gender‐disaggregated reporting. Further assessment is required to evaluate whether loneliness is associated with health and well‐being outcomes after a CVD event. [ABSTRACT FROM AUTHOR]

Aim: Neuroendocrine tumors (NETs) are an uncommon cancer and difficult to diagnose and treat. Treatment is complicated by debilitating side effects, impacting quality of life. This Australia‐wide survey aimed to increase our understanding of the impact and burden of NETs on patient quality of life (QoL) and to assess the benefit of a patient support program (eSHINE). Method: Consented patients from the eSHINE mailing list (n = 267) were invited to participate in an electronic self‐reported survey comprising 29 questions on clinical characteristics, diagnosis, sociodemographics, impact of living with NETs and benefits of a patient support program. No formal sample size was calculated. All analyses were descriptive. Results: A total of 144 participants (54%) responded. A total of 129 (48%) completed all questions. Approximately half of respondents were female, from metropolitan and rural areas, aged over 65 years and had a primary diagnosis of gastrointestinal NETs. Fifty‐eight percent had been diagnosed over 5 years ago. Twenty‐seven percent reported seeing four or more healthcare professionals prior to being diagnosed. Living with NETs had a large impact on patients' QoL. 83.5% reported fatigue, 76% felt their emotional health was impacted by NETs and 75% reported reduced ability to participate in leisure activities. Access to a supportive network to manage and treat NETs was extremely important to participants. Eighty‐five percent of respondents reported the eSHINE program had a positive impact on their QoL. Conclusion: Patients value support from healthcare professionals and patient support programs such as eSHINE in managing NETs. The eSHINE Patient Support Program has a positive impact on patient QoL. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology, critical care resource use of and outcomes from an intensive care admission for a skin or soft tissue infection in Central Australia. Design: Retrospective database review of prospectively collected data identifying all patients requiring admission for a life‐threatening illness related to a skin or soft tissue infection. Setting: Intensive care unit Alice Springs Hospital. Participants: All patients admitted with a primary diagnosis of skin or soft tissue infection between 2010 and 2016. Main outcome measure: Annualised incidence of skin or soft tissue infection requiring intensive care. Secondary outcomes examined resource use (length of stay, mechanical ventilation) and a description of the microbiology of skin or soft tissue infection in Central Australia. Results: There were 80 admissions to the intensive care unit over the sampling period, yielding an annualised incidence of 24.2 intensive care unit admissions per 100 000 population. Eighty‐five per cent were Indigenous with high rates of co‐morbid disease including poorly controlled type 2 diabetes, haemodialysis‐dependent chronic kidney disease and co‐infection with human T‐cell lymphocytic virus. The predominant type of skin or soft tissue infection was abscess, predominantly below the waist. Gram‐positive cocci comprised 50% of the organisms cultured, and 20% of organisms were multi‐resistant. Mortality was 0% and 1.3% at 28 and 90 days respectively. Conclusion: The annualised incidence of skin or soft tissue infection requiring intensive care support in Central Australia is higher than expected. This probably reflects the high burden of chronic disease and poor living conditions. While there is no mortality burden associated with skin or soft tissue infection in Central Australia, there is substantial morbidity. The data from this study adds weight to the call for improved primary health resources for this group. [ABSTRACT FROM AUTHOR]

Issue Addressed: Australian women are less likely to participate in recommended levels of weekly physical activity compared with men. Physical activity participation rates decrease with geographical remoteness. Research suggests that a lack of social support mechanisms within the home environment may act as a barrier for rural women to engage in physical activity, along with discomfort experienced within exercise environments. The purpose of this study was to explore the social conditions that facilitate or inhibit physical activity participation amongst women from two rural South Australian communities., Methods: A qualitative descriptive approach underpinned by a phenomenological methodological orientation was applied. Participants were recruited using a purposive sampling strategy before semi-structured interviews (N = 16) were conducted and prepared for thematic analysis., Results: Four inter-related themes were identified: support from others, time, expectations and available opportunities. Further contextual analysis revealed interwoven notions of physical activity spaces, time and social context within the themes., Conclusions: Multiple types of regulators interact to shape the motivational pattern of an individual. The themes identified align with self-determination, transactional and structuration theory, suggesting a need to consider human behaviour both pragmatically and conceptually. SO WHAT?: Results provide insight into social barriers and facilitators for physical activity participation and concomitantly provide the initial development of a framework for local strategic planning of health-promoting activities, and individual reflection to increase physical activity participation amongst rural women., (© 2020 Australian Health Promotion Association.)

This ethnographic study was designed to explore living conditions among a group of aboriginal families residing in an urban context, who participated in a recreational social program. The aim of the study was to explore life satisfaction by analyzing their living conditions and cultural capital inscribed in established attitudes, perceptions, and lay knowledge. Fieldwork was carried out in two complementary phases: phase 1, between May 2008 and December 2010, began when the first listed author initiated volunteer work with the organization responsible for the program; in phase 2, which extended from January 2011 to February 2013, participant observation was intensified and semi-structured interviews were carried out. The results indicate that the process of cultural uprooting underscores the experience of social inequality, and suggest a cohort effect that continues to this day. This process of cultural (in)consonance must be taken into account as a key factor when analyzing the living conditions and well-being of ethnic minorities, as well as when developing programs and interventions.

Objective: To evaluate the first three years of a national program to improve the social and emotional wellbeing of Indigenous youth in remote and regional Australia., Methods: Combination of open inquiry and audit review involving investigation of process and outcomes, with a broad national overview supplemented by five in-depth case studies in diverse settings., Results: Community development principles were applied at all 14 sites. There were many examples of collaborative, community-driven health promotion initiatives, with most progress observed where there were strong local partnerships. Within the range of activities, education sessions on alcohol and other drugs, mental health and violence were facilitated by program staff. There was a tension between community development and specific program delivery, with the balance reflecting the needs and capacity of individual sites, program staff expertise and contractual requirements., Conclusions and Implications: The main lessons concern program design and resourcing and ways of working. Program staff at each site learned to be not too ambitious, but to work consistently with the community, establishing partnerships and engaging and training community members. Community and stakeholder capacity enhancement should be regarded as core, and evaluation built in. Activities directed at youth must be engaging and effective, and integrated with other programs and services., (© 2015 The Authors.)

Introduction: Difficulties associated with communication are thought to contribute to adverse perinatal outcomes experienced by refugee background women living in developed countries. This study explored Afghan women and men's experience of language support during pregnancy, labour and birth, and health professionals' experiences of communicating with clients of refugee background with low English proficiency., Methods: Interviews were conducted with (1) Afghan women and men in the first year after having a baby in Australia, by multilingual, bicultural researchers and (2) midwives and medical practitioners providing care to families of refugee background. Analysis was conducted thematically., Results: Sixteen Afghan women, 14 Afghan men, 10 midwives, five medical practitioners and 19 community-based health professionals (refugee health nurses, bicultural workers, counsellors) providing maternity or early postnatal care participated. Midwife and medical informants concurred that accredited interpreters are generally booked for the first pregnancy visit, but not routinely used for other appointments. Very few Afghan participants reported access to on-site interpreters. Men commonly interpreted for their wives. There was minimal professional interpreting support for imaging and pathology screening appointments or during labour and birth. Health professionals noted challenges in negotiating interpreting services when men were insistent on providing language support for their wives and difficulties in managing interpreter-mediated visits within standard appointment times. Failure to engage interpreters was apparent even when accredited interpreters were available and at no cost to the client or provider., Conclusions: Improving identification of language needs at point of entry into healthcare, developing innovative ways to engage interpreters as integral members of multidisciplinary healthcare teams and building health professionals' capacity to respond to language needs are critical to reducing social inequalities in maternal and child health outcomes for refugee and other migrant populations., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Refugees have poor mental, social and physical health related to experiences of trauma and stresses associated with settlement, however little is known about how refugee families experience maternity and early childhood services. The aim of this study was to explore the responsiveness of health services to the social and mental health of Afghan women and men at the time of having a baby., Method: Participatory methods including community engagement and consultation with the Afghan community and service providers in Melbourne, Australia. Bicultural researchers conducted interviews with Afghan women and men who had recently had a baby. Interviews and focus groups were also conducted with health professionals working in the region., Results: Thirty interviews were conducted with Afghan women and men who had recently had a baby. Thirty-four health professionals participated in an interview or focus group.Afghan women and men reported significant social hardship during the period before and after having a baby in Australia, but were rarely asked about their social health by maternity and early childhood services.Most health professionals recognised that knowledge and understanding of their client's migration history and social circumstances was relevant to the provision of high quality care. However, inquiring about refugee background, and responding to non-clinical needs of refugee families was challenging for many health professionals. Factors that made it more difficult for health professionals to engage with Afghan families in pregnancy included limited understanding of the context of migration, dependency of many Afghan women on their husband for interpreting, short appointments, and the high likelihood of seeing different health professionals at each antenatal visit. Community-based maternal and child health nurses had more scope to work with interpreters, and build relationships with families, providing a stronger foundation for identifying and responding to complex social circumstances., Conclusion: There are significant challenges in providing comprehensive, high quality primary health care for Afghan families accessing Australian maternity and early childhood services. The limited capacity of public maternity services to identify families of refugee background and provide tailored service responses are contributing to inequitable maternal and child health outcomes for families of refugee background.

Background: Squalor is an epiphenomenon associated with a range of medical and psychiatric conditions. People living in squalor are not well described in the literature, and prior work has indicated that up to 50% do not have a psychiatric diagnosis. Squalor appears to be linked with neuropsychological deficits suggestive of the presence of impaired executive function. We present a case series of people living in squalor that examines their neuropsychological assessment and diagnosis., Methods: Clinicians from local health networks were invited to submit neuropsychological reports of patients living in squalor. These selected reports were screened to ensure the presence of squalor and a comprehensive examination of a set of core neuropsychological domains. Assessments were included if basic attention, visuospatial reasoning, information processing speed, memory function, and executive function were assessed., Results: Sixty-nine neuropsychological reports were included. Sixty-eight per cent of the group underwent neuropsychological assessments during an inpatient admission. For participants where it was available (52/69), the mean Mini-Mental State Examination score was 25.29 (SD = 3.96). Neuropsychological assessment showed a range of cognitive impairment with nearly all the participants (92.75%) found to have frontal executive dysfunction. One person had an unimpaired neuropsychological assessment. Results indicated that dorsolateral prefrontal rather than orbitofrontal functions were more likely to be impaired. Vascular etiology was the most common cause implicated by neuropsychologists., Conclusions: Frontal executive dysfunction was a prominent finding in the neuropsychological profiles of our sample of squalor patients, regardless of their underlying medical or psychiatric diagnoses. Our study highlights the importance of considering executive dysfunction when assessing patients who live in squalor.

Background: Improvements in health are an important expected outcome of many housing infrastructure programs. The authors aimed to determine if improvement in the notoriously poor housing infrastructure in Australian Indigenous communities results in reduction in common childhood illness and to identify important mediating factors in this relationship., Methods: The authors conducted a prospective cohort study of 418 children aged 7 years or younger in 10 Australian Indigenous communities, which benefited most substantially from government-funded housing programs over 2004-2005. Data on functional and hygienic state of houses, reports of common childhood illness and on socio-economic conditions were collected through inspection of household infrastructure and interviews with children's carers and householders., Results: After adjustment for a range of potential confounding variables, the analysis showed no consistent reduction in carers' reporting of common childhood illnesses in association with improvements in household infrastructure, either for specific illnesses or for these illnesses in general. While there was strong association between improvement in household infrastructure and improvement of hygienic condition of the house, there were only marginal improvements in crowding., Conclusions: High levels of household crowding and poor social, economic and environmental conditions in many Australian Indigenous communities appear to place major constraints on the potential for building programs to impact on the occurrence of common childhood illness. These findings reinforce the need for building programs to be supported by a range of social, behavioural and community-wide environmental interventions in order for the potential health gains of improved housing to be more fully realised.

Increasing international mobility presents a risk for communicable disease transmission. Overseas-acquired HIV infections have been increasingly observed across Australian jurisdictions. This includes a mix of men emigrating from countries with high HIV prevalence and men travelling abroad. There is currently little research exploring international mobility and HIV risk, and as a consequence the increase of men acquiring HIV while travelling overseas is poorly understood. This paper draws on data from a qualitative study exploring the risk perspectives and experiences of 14 Australian men who acquired HIV while travelling overseas in the years between 2000 and 2009. Participants articulated a strong desire to distance themselves from the identity of a tourist. Social networks were highlighted as important entry points to engage with other foreign travellers and expatriates. These networks were highly influential and were understood by the participants to provide guidance on how they should negotiate the local scene, including where to meet sex partners. Limited discussion of safe sex and HIV was mentioned in these contexts. The findings suggest that prevalent social norms and social networks play an influential role in how participants negotiate sex and social relations in overseas settings. These networks could potentially provide sites for effective HIV-prevention programmes.

Good laws are a necessary, but not a sufficient, condition for the provision of good health care. At the end of life, there is a need for laws that foster and encourage the best possible outcomes for patients, their families and healthcare professionals. This article proposes five desiderata for laws at the end of life. It uses the emerging Australian jurisprudence of end-of-life decision making to test and examine the desiderata. The article also proposes that poorly drafted and confusing laws may have a deleterious effect on patient care. These nomoigenic (law-caused) harms can be avoided by adherence to the five desiderata of death law., (Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Young people with disabilities have poorer mental health than their non-disabled peers. However, people with disabilities are more likely than others to experience financial hardship and low social support, both of which have been linked with poor mental health outcomes. This article explores the extent to which the relatively poor mental health of young people with disabilities is related to the social conditions in which they live., Methods: Secondary analysis was performed on Wave 6 (2006) of the survey of Household Income and Labour Dynamics in Australia (HILDA). This nationally representative sample included 3,392 young Australians, aged 15-29, of whom 475 reported having a long-term health condition, impairment or disability., Results: Young people with disabilities reported poorer mental health than their non-disabled peers. However, this relationship was moderated by both social adversity and social support, with minimal differences in mental health observed between the groups under conditions of high social support and low financial hardship., Discussion: The results suggest that disability represents a potential adversity that may be exacerbated or ameliorated by the effects of wealth/financial hardship and social support., Conclusion: It may be possible to improve the mental health of disabled people by addressing their social exclusion.

The effects of viewing different types of information were investigated in people judging the social acceptability of alternative forest harvest systems. Approximately 500 Tasmanians were shown still-simulated images of four harvest systems (a clearfell system, two aggregated retention systems, and a selective system) and were asked to judge their acceptability. Individual interviews were conducted with 12 of the participants. It was anticipated that people holding different beliefs about the consequences of harvesting would have different responses to information. Cluster analysis was used to group participants according to these beliefs. Responses to still images were compared with responses to two other types of information: information about consequences of the harvest systems in the form of indicator symbols, and information about regeneration over time, presented as visual animations. The effects of information differed across both harvest system and belief cluster groups of participants. The largest effects of information occurred in people who held a mix of beliefs about consequences. Within this group, participants who viewed the indicators rated a 30% aggregated retention system higher and selective harvesting lower, than those who did not view the indicators. Viewing animated sequences led to slightly higher ratings of the more intensive harvest systems and significantly lower ratings of the selective harvest system than those based on the still images. The interview data provided examples of interviewees viewing information critically against their own values and beliefs. Only some interviewees appeared to use it in judging social acceptability.

The absence of pleasure in harm reduction discourse is more and more frequently noted, but few have considered what, exactly, more attention to pleasure might do. What is the value of pleasure for harm reduction praxis? Central to such an inquiry is the question of how pleasure is grasped, conceptually and methodologically. In this paper I use Foucault's History of Sexuality to elaborate a perspective on the use of pleasure within harm reduction. I argue that Foucault's work suggests a distinction between therapeutic and social-pragmatic approaches to pleasure, and that such a distinction is important for harm reduction--to the extent that it seeks to maintain a critical awareness of the relation between stigma and care--in that the latter model raises the possibility of maintaining de-pathologizing modes of care. An appreciation of pleasure in terms of its social pragmatics helps to recognize practices of safety, care and risk that might otherwise go unregistered in the current punitive political environment. It provides a basis for conceiving practical measures that are in touch with given concerns and bodily practices, and thus have more chance of being taken up. It also enables a more dynamic and responsive approach to the practice of bodies and pleasures.

Background: While the pleasures of drug use are sometimes acknowledged, they are normally limited to those who are socially privileged. The drug use of those who are impoverished and marginalised is linked instead to crime, social misery and addiction. Studying poverty in connection with drug use enriches our understanding of both poverty and drugs, but there are limitations to these connections, including their neglect of pleasure., Method: This paper draws on 85 qualitative interviews with service providers and clients, conducted for a project entitled 'Comparing the role of takeaways in methadone maintenance treatment in New South Wales and Victoria'. Critical readings of psychoanalysis are used as a conceptual frame., Results: Although pleasurable and problematic drug use are often thought to be mutually exclusive, pleasure is reported from both the effects of drugs such as heroin and methadone, and from the social worlds of methadone maintenance treatment. Attention to drug users' narratives of pleasure has the potential for new understandings of drug use and social disadvantage., Conclusion: Common distinctions between kinds of drug use, such as problematic and recreational, are less useful than is normally thought.

We report first results from the Australian Genetic Discrimination Project of clinical genetics services clients' perceptions and experiences regarding alleged differential treatment associated with having genetic information. Adults (n = 2667) who had presented from 1998 to 2003 regarding predictive or presymptomatic testing for designated mature-onset conditions were surveyed; 951/1185 respondents met inclusion criteria for current asymptomatic status. Neurological conditions and familial cancers were primary relevant conditions for 87% of asymptomatic respondents. Specific incidents of alleged negative treatment, reported by 10% (n = 93) of respondents, occurred in life insurance (42%), employment (5%), family (22%), social (11%) and health (20%) domains. Respondents where neuro-degenerative conditions were relevant were more likely overall to report incidents and significantly more likely to report incidents in the social domain. Most incidents in the post-test period occurred in the first year after testing. Only 15% of respondents knew where to complain officially if treated negatively because of genetics issues. Recommendations include the need for increased community and clinical education regarding genetic discrimination, for extended clinical genetics sector engagement and for co-ordinated monitoring, research and policy development at national levels in order for the full benefits of genetic testing technology to be realised.

Layperson accounts of depression are gaining increasing prominence in the health research literature. This paper considers the accounts of lay people from a cross-cultural perspective. By exploring lay concepts of distress from Anglo-Australian, Ethiopian and Somali communities in Australia, we describe commonalities and divergences in understandings of depression. A total of 62 Anglo-Australians were interviewed, and 30 Somali and Ethiopians participated in focus groups and individual interviews. Anglo-Australian accounts frequently portray depression as an individual experience framed within narratives of personal misfortune, and which is socially isolating. In the accounts of distress from the Somali and Ethiopian refugees living in Australia, family and broader socio-political events and circumstances featured more frequently, and 'depression' was often framed as an affliction that was collectively derived and experienced.

Objective: To examine whether television news and current affairs coverage of overweight and obesity frames obesity in ways that support or oppose efforts to combat obesity., Design and Setting: A content and framing analysis of a structured sample of 50 television news and current affairs items about overweight and obesity broadcast by five free-to-air television channels in New South Wales between 2 May and 31 October 2005., Main Outcome Measures: Dominant discourses about causes of overweight and obesity; proposed solutions and location of responsibility for the problem; the age-group focus of television items; the relative prominence of stakeholders; and the aspects of obesity which attract news attention., Results: Most television items (72%) framed obesity as a problem of poor nutrition. Obesity was largely seen as the responsibility of individuals (66% of items). Just over half of news items (52%) focused only on adults while 26% focused only on children. Obesity was framed largely as a problem to be solved by individual nutritional changes, exercise and surgical and medical interventions., Conclusions: While individual lifestyle is crucial to controlling weight, the research community now recognises the importance of sociocultural and environmental factors as drivers of the obesity epidemic. However, television news portrays obesity largely as an individual problem with individual solutions centred mostly on nutrition. Media emphasis on personal responsibility and diet may detract attention from the sociopolitical and structural changes needed to tackle overweight and obesity at a population level.

Objectives: This paper describes a research program that has operationalized the links between empowerment at personal/family, group/organizational and community/structural levels and successful mechanisms to address Indigenous social and emotional wellbeing issues such as family violence and abuse, suicide prevention and incarceration., Methods: A two-pronged approach, involving the Family Wellbeing Empowerment Program and Participatory Action Research, was used to enhance the capacity of program participants and their communities to take greater charge of issues affecting their health and wellbeing., Results: Key program outcomes include an enhancement of participants' sense of self worth, resilience, problem-solving ability, ability to address immediate family difficulties as well as belief in the mutability of the social environment. There is also evidence of increasing capacity to address wider structural issues such as poor school attendance rates, the critical housing shortage, endemic family violence, alcohol and drug misuse, chronic disease, and over-representation of Indigenous men in the criminal justice system. Participants are also breaking new ground in areas such as values-based Indigenous workforce development and organizational change, as well as issues about contemporary Indigenous spirituality., Conclusions: The use of a long-term (10-year) community research strategy focussing directly on empowerment has demonstrated the power of this approach to facilitate Indigenous people's capacity to regain social and emotional wellbeing and begin to rebuild the social norms of their families and community.

Objective: Trauma experienced repeatedly over generations by Aboriginal people reverberates through tight-knit community networks and has laid down layers of psychic pain and community disruption. Healing methods that touch both individuals and communities are required. The Aboriginal Healing Foundation (AHF) has sponsored and evaluated community initiatives to address the legacy of Indian residential schools over a 7-year period. The analysis contained in its final report begins to create an empirical base for healing approaches grounded in Indigenous knowledge. The AHF commissioned quantitative and qualitative research on community projects and their impacts over the 7 years of its first mandate. This article extracts key themes from the resulting analysis., Results: Individuals and communities engaged in healing from the legacy of residential schools move through four stages that are both sequential and recurring. Data from projects and individual participants identify promising approaches to support progress. Key findings include: (i) community healing is a necessary complement to individual healing; (ii) culture is good medicine; (iii) reservoirs of resilience in individuals and communities can be tapped; (iv) it takes time to heal; (v) service infrastructure and continuity are necessary to consolidate individual healing and assist communities who are 'hitting the wall' in their healing journey; and (vi) as individuals and communities heal, the depth and complexity of needs become evident, generating demand for training.

Objective: Fred Myers described kanyirninpa (holding) as a deeply embedded value for desert Aboriginal people. He explained it as authority with nurturance where older people 'grew up' and protected younger people. Can a cultural understanding of kanyirninpa provide any insight or response to the high rates of suicide among young Aboriginal men today?, Method: This paper draws on qualitative health research that was conducted among desert communities in the southeast Kimberley region of Western Australia between 2001 and 2004. The research was primarily with men and explored cultural understandings of the particular male expressions and praxis of kanyirninpa. The research also occurred at a time when the first suicides of young men, who had grown up within this desert region, were taking place., Results: Research showed that the fracture of kanyirninpa over recent generations has seriously affected key social processes and generational relationships within desert society. This wounding has implications for men's health and can provide an understanding as to why young men attempt self-harm and suicide. However, the social expression of kanyirninpa can also sustain important meanings for young men as they grow up. It can protect them from high-risk behaviour and self-harm., Conclusions: While the experience of suicide continues to deeply wound Aboriginal families and communities, desert people's efforts to sustain and express kanyirninpa offers hope. This is a social process and relationship that can help inform health policy and practice in response to self-harm, suicide ideation and behaviour, particularly for young Aboriginal men.

Background: There are few national or cross-cultural studies of the stigma associated with mental disorders. Australia and Japan have different systems of psychiatric health care, and distinct differences in cultural values, but enjoy similar standards of living. This study seeks to compare the nature and extent of stigma among the public in the two countries., Methods: A household survey of the public was conducted in each country using similar methodologies. The Australian study comprised a national survey of 3998 adults aged over 18 years. The Japanese survey involved 2000 adults aged 20 to 69 from 25 regional sites distributed across the country. Interviewees reported their personal attitudes (personal stigma, social distance) and perceptions of the attitudes of others (perceived stigma, perceived discrimination) in the community with respect to four case vignettes. These vignettes described a person with: depression; depression with suicidal ideation; early schizophrenia; and chronic schizophrenia., Results: Personal stigma and social distance were typically greater among the Japanese than the Australian public whereas the reverse was true with respect to the perception of the attitudes and discriminatory behaviour of others. In both countries, personal stigma was significantly greater than perceived stigma. The public in both countries showed evidence of greater social distance, greater personal stigma and greater perceived stigma for schizophrenia (particularly in its chronic form) than for depression. There was little evidence of a difference in stigma for depression with and without suicide for either country. However, social distance was greater for chronic compared to early schizophrenia for the Australian public., Conclusion: Stigmatising attitudes were common in both countries, but negative attitudes were greater among the Japanese than the Australian public. The results suggest that there is a need to implement national public awareness interventions tailored to the needs of each country. The current results provide a baseline for future tracking of national stigma levels in each country.

Adaptive management is an approach to managing natural resources that emphasizes learning from the implementation of policies and strategies. Adaptive management appears to offer a solution to the management gridlock caused by increasing complexity and uncertainty. The concept of adaptive management has been embraced by natural resource managers worldwide, but there are relatively few published examples of adaptive management in use. In this article, we explore two watershed management projects in southeastern Australia to better understand the potential of adaptive management in regional scale programs through qualitative, case study-based investigation. The program logic of one case implies the use of passive adaptive management, whereas the second case claims to be based on active adaptive management. Data were created using participant observation, semistructured interviews with individuals and groups, and document review. Using thematic content and metaphor analysis to explore the case data, we found that each case was successful as an implementation project. However, the use of both passive and active adaptive management was constrained by deeply entrenched social norms and institutional frameworks. We identified seven "imperatives" that guided the behavior of project stakeholders, and that have consequences for the use of adaptive management. Reference to recent evaluations of the Adaptive Management Areas of the Pacific Northwest of the United States suggests that some of these imperatives and their consequences have broad applicability. The implications of our findings are discussed, and suggestions for improving the outcomes of regional scale adaptive management are provided.

Objective: Decades of health-related research have produced a large body of knowledge describing alarming rates of morbidity, mortality and social/cultural disruption among Indigenous Australians, but have failed to deliver sustainable interventions to arrest the deepening spiral of ill-health. This paper explores the potential of Indigenous natural resource management (NRM) activities to promote and preserve Indigenous health in remote areas of northern Australia., Method: A literature review of the health, social science and ecology peer-reviewed journals and secondary literature., Conclusions and Implications: Effective interventions in Indigenous health will require trans-disciplinary, holistic approaches that explicitly incorporate Indigenous health beliefs and engage with the social and cultural drivers of health. Aboriginal peoples maintain a strong belief that continued association with and caring for ancestral lands is a key determinant of health. Individual engagement with 'country' provides opportunities for physical activity and improved diet as well as boosting individual autonomy and self-esteem. Internationally, such culturally congruent health promotion activities have been successful in programs targeting substance abuse and chronic diseases. NRM is fundamental to the maintenance of biodiversity of northern Australia. Increased support for Indigenous involvement in land and sea NRM programs would also deliver concrete social benefits for communities including opportunities for sustainable and culturally apt regional employment, applied education and economic development. NRM may also reinvigorate societal/cultural constructs, increasing collective esteem and social cohesion.

Background: Occupational deprivation as a concept has been presented and discussed in the occupational therapy and occupational science literature for the past several years. The discussion to date, however, has been largely exploratory and theoretical in nature., Purpose: This article represents the author's attempt to further understandings of occupational deprivation as a lived experience through research undertaken with Kosovar refugees living in Australia., Method and Result: The article focuses on the story of one of the participants of the study which is presented as a case study to illuminate aspects of occupational deprivation as a process occurring over time. The case study is interwoven with interpretive commentary, which serves to highlight key issues as to how occupational deprivation may be experienced by groups of people in different cultural, historic and societal contexts and how it may therefore be addressed by occupational therapists., Practice Implications: The article concludes with reflections on future directions with respect to both further research and professional action. In particular, the focus of professional action is oriented to a population-based approach.

Although differences in self-conception across cultures have been well researched, regional differences within a culture have escaped attention. The present study examined individual, relational, and collective selves, which capture people's conceptions of themselves in relation to their goals, significant others, and in groups, comparing Australians and Japanese participants living in regional cities and metropolitan areas. Culture, gender, and urbanism were found to be related to individual, relational, and collective selves, respectively. Australians emphasized individual self more than Japanese, women stressed relational self more than men, and residents in regional cities regarded collective self as more important than their counterparts in metropolitan areas. These findings provide support for the tripartite division of the self and suggest a need to construct a culture theory that links self and societal processes.

Wetlands in Australia provide considerable ecological, economic, environmental and social benefits. However, the use of wetlands has been indiscriminate and significant damage to many Australian wetlands has occurred. During the last 150 years one third of the wetlands in Victoria have been lost. A conspicuous problem in wetland management is the paucity of involvement by stakeholders. This paper uses the Analytic Hierarchy Process (AHP) to incorporate stakeholder objectives in the 'Wonga Wetlands' on the Murray River. The study shows that the AHP can explicitly incorporate stakeholder preferences and multiple objectives to evaluate management options. The AHP also provides several approaches for policy makers to arrive at policy decisions.

The author takes up the challenge from social psychologists to explore the coping responses of those who experience racism. Previous attempts to provide taxonomies of responses to racism-discrimination-oppression are reviewed. An analysis of data derived from semistructured interviews conducted with 34 Indigenous Australians that explored experiences of racism and emotional and behavioral responses is reported, and a taxonomy of coping made up of 3 broad categories is presented. The defining feature of these categories is the purpose of the responses contained therein: to defend the self, to control or contain the reaction, or to confront the racism. It is argued that this may be a more useful way to understand responses to racism than taxonomies previously proposed.